How do I care for my ostomy?

Proper care for your
ostomy includes learning how to empty and replace the pouch and knowing what to watch for.

Some people choose
to
irrigate a colostomy. Irrigation is a procedure in
which you stimulate and flush the intestines at a regular time to control when
you eliminate solid wastes.

Note: If you are caring for an infant or child
with an ostomy, the same information and procedures generally apply. But the
ostomy pouch will be smaller and will most likely need to be replaced more often.
Different adhesives may be used to attach the pouch because a child's skin is
more sensitive than an adult's skin. Your wound, ostomy, and continence nurse
(WOCN) will help you learn how to care for your child with an ostomy.
Irrigation is not appropriate for children.

Emptying your ostomy pouch

Ostomy pouches can be
drainable or closed. A drainable pouch opens at one end to allow you to empty
it. A closed pouch is disposed of and replaced with a new one as needed.

The pouch fills with waste and gas. It is best to empty the pouch
when it is one-third to one-half full. This prevents the pouch from getting too
full and heavy and pulling off. Many people routinely empty the pouch each time
they urinate.

Drainable pouch. Place some toilet paper in the
bowl to prevent splashing. Sit down on the toilet with the pouch between your
legs. The pouch is usually held shut with a clip system. Simply unclip it and
allow its contents to fall into the toilet. Clean the end of the pouch with
toilet paper and reclip it.

Closed pouch. Unsnap the pouch from the barrier
and dispose of it. Do not flush it down the toilet. Putting the pouch in a
ziplock bag reduces odor. You then need to attach a new pouch.

Replacing your ostomy pouch

How often you change your ostomy pouch depends on many things, including the type of stoma you have and what you prefer. Some pouching systems are changed daily. Others are changed every 3 to 7 days. You may need to change your pouching system more often if there is a leak in the pouch or
itching or burning under the barrier. The pouch itself is usually emptied or replaced
after each bowel movement.

Prepare the new pouch and barrier. Cut an opening
in the new barrier slightly larger than the stoma. You may also have a precut
barrier. If you have a two-piece system, snap the pouch to the barrier. Remove
the paper backing from the barrier so that the adhesive is exposed. You may
need to use some skin barrier paste to obtain a better skin seal.

Remove the old pouch and barrier. Remove your old
pouch by peeling away the barrier and gently lifting the pouch while pressing
down on the skin below the pouch. Be sure not to irritate the skin as you
remove the barrier and pouch. If the pouch is sticking and is difficult to
remove, use an adhesive remover underneath the barrier. Dispose of the old
pouch and barrier.

Clean your skin. Clean your skin and stoma with a
wet washcloth or wipe. You may shower to clean the stoma. You may use soap, but
if you do, rinse well. Allow your skin to dry and check your skin and stoma for
signs of irritation. See Treating skin irritation below.

Measure your stoma, if necessary. After your
surgery, the size of your stoma may change. Your doctor may want you to measure
it and will provide a measurement guide to help you do this.

Put the new pouch on. Position the opening in the
barrier around the stoma and apply the sticky side to the skin. Press down
until all edges are sealed. If your pouch is open-ended, attach the
clip.

Treating skin irritation

If the skin under your pouch is red, irritated, or itchy,
you need to treat your skin. Follow these steps:

Gently remove the pouch.

Clean
the skin under the pouch with water.

Dry the
skin.

Sprinkle ostomy protective powder on the skin and then blot
it off.

Reattach or replace the pouching system.

If you continue to have skin irritation, consult your
wound, ostomy, and continence nurse (WOCN) or another nurse or a doctor.

Irrigating a colostomy

Irrigating a colostomy
allows more control over the elimination of waste, because it stimulates the
intestine to function at a regular time. It is typically done at the same time
every day or every other day. If you irrigate, you may need only a cover or pad
over your stoma and may not need an ostomy pouch.

Children do not
use irrigation.

Only a colostomy can be irrigated. You cannot
irrigate an ileostomy.

To irrigate a colostomy, you need to have
all of the following equipment and supplies ready, including:

Lubricant.

An irrigation set,
which includes a container for water, tubing with a cone end (one end of the
tubing attaches to the container and the cone end is inserted into the stoma),
and a clamp.

An irrigating sleeve and belt. (The sleeve is a long,
clear plastic bag, open at the top and bottom. It snaps onto the
barrier.)

Toilet tissue.

A toilet to dispose of
waste.

A two-piece pouch system is usually used for
irrigation. A nurse or doctor will show you how to irrigate your colostomy. The
basic procedure is as follows.

Getting ready

Place
16 fl oz (473 mL) to
32 fl oz (946 mL) of lukewarm
water (cold water can cause cramping) in the container to use as irrigation
solution. The exact amount depends on the person. Your nurse or doctor will
help you determine the amount you need.

Hang the container at
about shoulder height—18 in. (46 cm) to 24 in. (61 cm)
above your stoma. You will need a hook or other device to do
this.

Find a comfortable position, such as in a chair in front of
the toilet or on the toilet.

Preparing the equipment

Remove your colostomy pouch from the
barrier and snap the irrigation sleeve to the barrier. Attach the sleeve belt
for security, and place the end of the sleeve in the toilet, bedpan, or other
disposal unit.

Unclamp the tubing to let some of the irrigation
solution flow through the tubing and out the cone. This removes air from the
tubing.

Reclamp the tube.

Lubricate the irrigating
cone and gently insert the cone into the stoma through the upper opening in the
sleeve. Press the cone firmly but gently. Do not force the cone into the stoma
or insert it more than
3 in. (7.6 cm) into the
stoma.

Irrigating

Unclamp the tube and allow the irrigation
solution to flow into the stoma slowly for 5 to 10 minutes. If cramping occurs,
stop the flow for a few seconds but leave the cone in place.

When
the desired amount of solution flows in, or when you feel full, clamp the
tubing and remove the irrigation cone from your stoma. Waste will come out of
the stoma and empty through the sleeve into the toilet or other disposal unit.

It takes 30 to 45 minutes for all the waste to empty. But after
the initial flow of waste slows down (10 to 15 minutes), you may clamp the
sleeve shut at the bottom and move around. Many people use this time for
shaving and other grooming.

When the waste return is completed,
unsnap the sleeve and put on your usual pouch or covering.

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